tbuckley/cabot-search huggingface dataset:
National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations
Authors: James A. Diao, Gloria J. Wu, Jason K. Wang, Isaac S. Kohane, Herman A. Taylor, Hocine Tighiouart, Andrew S. Levey, Lesley A. Inker, Neil R. Powe, Arjun K. Manrai
Journal: Journal of the American Society of Nephrology (2022)

Significance Statement A national task force convened by the NKF-ASN recently recommended a new race-free creatinine equation for calculating eGFR. Although this equation is expected to be widely adopted, its broad effect on recommended clinical care across the eGFR spectrum and across different racial and ethnic groups is not known. The authors used nationally representative data from 44,360 participants in NHANES to quantify expected changes to recommended care. They found that nationwide implementation of the new creatinine-based eGFR equation may affect recommended care for hundreds of thousands of Black adults and millions of non-Black adults, including new CKD diagnoses and reversals, CKD stage reclassifications, and changes in kidney donation eligibility, nephrologist referral, and medication dosing. Background The National Kidney Foundation and American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease recently recommended a new race-free creatinine-based equation for eGFR. The effect on recommended clinical care across race and ethnicity groups is unknown. Methods We analyzed nationally representative cross-sectional questionnaires and medical examinations from 44,360 participants collected between 2001 and 2018 by the National Health and Nutrition Examination Survey. We quantified the number and proportion of Black, White, Hispanic, and Asian/Other adults with guideline-recommended changes in care. Results The new equation, if applied nationally, could assign new CKD diagnoses to 434,000 (95% confidence interval [CI], 350,000 to 517,000) Black adults, reclassify 584,000 (95% CI, 508,000 to 667,000) to more advanced stages of CKD, restrict kidney donation eligibility for 246,000 (95% CI, 189,000 to 303,000), expand nephrologist referrals for 41,800 (95% CI, 19,800 to 63,800), and reduce medication dosing for 222,000 (95% CI, 169,000 to 275,000). Among non-Black adults, these changes may undo CKD diagnoses for 5.51 million (95% CI, 4.86 million to 6.16 million), reclassify 4.59 million (95% CI, 4.28 million to 4.92 million) to less advanced stages of CKD, expand kidney donation eligibility for 3.96 million (95% CI, 3.46 million to 4.46 million), reverse nephrologist referral for 75,800 (95% CI, 35,400 to 116,000), and reverse medication dose reductions for 1.47 million (95% CI, 1.22 million to 1.73 million). The racial and ethnic mix of the populations used to develop eGFR equations has a substantial effect on potential care changes. Conclusion The newly recommended 2021 CKD-EPI creatinine-based eGFR equation may result in substantial changes to recommended care for US patients of all racial and ethnic groups.
Genicular Nerve Block for Pain Management in Patients With Knee Osteoarthritis: A Randomized <scp>Placebo‐Controlled</scp> Trial
Authors: Ernst M. Shanahan, Lucinda Robinson, Suellen Lyne, Richard Woodman, Fin Cai, Kokum Dissanayake, Kate Paddick, Giovanna Cheung, Frank Voyvodic
Journal: Arthritis & Rheumatology (2022)

Objective This study was undertaken to determine the efficacy of ultrasound‐guided genicular nerve block (GNB) for the management of knee pain in patients with knee osteoarthritis. Methods We performed a 12‐week parallel‐group, placebo‐controlled randomized trial of GNB. Within 2 weeks of randomization, patients with knee osteoarthritis in the active arm received 3 injections of 5.7 mg celestone chronodose (1 ml) and 0.5% bupivacaine (3 ml) to the inferomedial, superomedial, and superolateral genicular nerves; patients with knee osteoarthritis in the placebo arm received injections of normal saline. At baseline and at weeks 2, 4, 8, and 12, patients recorded their pain and disability on a 100‐mm visual analog scale (VAS) (the primary outcome measure), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Intermittent and Constant Osteoarthritis Pain scale. Statistical significance was set at a 2‐sided Type I error of α = 0.0125 for comparisons at each of the 4 time points. We used a global perceived effect scale to measure patient satisfaction. Results The 59 patients (36 female, 23 male) who completed the trial had a mean ± SD age of 68.2 ± 8.6 years. Patients in the active group reported improvements in pain scores at 2, 4, 8, and 12 weeks with a diminution of the effect over time. VAS scores at baseline and at weeks 2, 4, 8, and 12 in the active group (n = 31) versus placebo group (n = 28) were 6.2 versus 5.3 ( P = 0.294), 2.7 versus 4.7 ( P &lt; 0.001), 3.2 versus 5.1 ( P &lt; 0.001), 3.9 versus 4.9 ( P &lt; 0.001), and 4.6 versus 5.1 ( P = 0.055), respectively. Total WOMAC scores at baseline and at weeks 2, 4, 6, 8, and 12 in the active group versus the placebo group were 54.5 versus 48.1 ( P = 0.177), 32.9 versus 44.4 ( P &lt; 0.001), 33.7 versus 45.8 ( P &lt; 0.001), 39.2 versus 44.8 ( P = 0.001), and 42.65 versus 45.1 ( P = 0.012), respectively. Conclusion GNB offers short‐term pain relief for knee osteoarthritis.
Cancer-selective metabolic vulnerabilities in MYC-amplified medulloblastoma
Authors: William D. Gwynne, Yujin Suk, Stefan Custers, Nicholas Mikolajewicz, Jeremy K. Chan, Zsolt Zador, Shawn C. Chafe, Kui Zhai, Laura Escudero, Cunjie Zhang, Olga Zaslaver, Chirayu Chokshi, Muhammad Vaseem Shaikh, David Bakhshinyan, Ian Burns, Iqra Chaudhry, Omri Nachmani, Daniel Mobilio, William T. Maich, Patricia Mero, Kevin R. Brown, Andrew T. Quaile, Chitra Venugopal, Jason Moffat, J. Rafael Montenegro-Burke, Sheila K. Singh
Journal: Cancer Cell (2022)
Potential Mediators of Oxaliplatin-Induced Peripheral Neuropathy From Adjuvant Therapy in Stage III Colon Cancer: Findings From CALGB (Alliance)/SWOG 80702
Authors: Seohyuk Lee, Chao Ma, Qian Shi, Pankaj Kumar, Felix Couture, Philip Kuebler, Smitha Krishnamurthi, DeQuincy Lewis, Benjamin Tan, Richard M. Goldberg, Alan Venook, Charles Blanke, Eileen M. O'Reilly, Anthony F. Shields, Jeffrey A. Meyerhardt
Journal: Journal of Clinical Oncology (2022)

PURPOSE We sought to evaluate the independent and interactive associations of planned treatment duration, celecoxib use, physical activity, body mass index (BMI), diabetes mellitus, and vitamin B6 with oxaliplatin-induced peripheral neuropathy (OIPN) among patients with stage III colon cancer enrolled in a clinical trial. METHODS We conducted a prospective, observational study of 2,450 patients with stage III colon cancer enrolled in the CALGB/SWOG 80702 trial, randomly assigned to 6 versus 12 cycles of adjuvant fluorouracil, leucovorin, and oxaliplatin chemotherapy with or without 3 years of celecoxib. OIPN was reported using the Common Terminology Criteria for Adverse Events (CTCAE) during and following completion of chemotherapy and the FACT/GOG-NTX-13 15-17 months after random assignment. Multivariate analyses were adjusted for baseline sociodemographic and clinical factors. RESULTS Patients assigned to 12 treatment cycles, relative to 6, were significantly more likely to experience higher-grade CTCAE- and FACT/GOG-NTX-13-reported neuropathy and longer times to resolution, while neither celecoxib nor vitamin B6 intake attenuated OIPN. Exercising ≥ 9 MET-hours per week after treatment relative to &lt; 9 was associated with improvements in FACT/GOG-NTX-13-reported OIPN (adjusted difference in means, 1.47; 95% CI, 0.49 to 2.45; P = .003). Compared with patients with baseline BMIs &lt; 25, those with BMIs ≥ 25 were at significantly greater risk of developing higher-grade CTCAE-reported OIPN during (adjusted odds ratio, 1.18; 95% CI, 1.00 to 1.40; P = .05) and following completion (adjusted odds ratio, 1.23; 95% CI, 1.01 to 1.50; P = .04) of oxaliplatin treatment. Patients with diabetes were significantly more likely to experience worse FACT/GOG-NTX-13-reported neuropathy relative to those without (adjusted difference in means, –2.0; 95% CI, –3.3 to –0.73; P = .002). There were no significant interactions between oxaliplatin treatment duration and any of these potentially modifiable exposures. CONCLUSION Lower physical activity, higher BMI, diabetes, and longer planned treatment duration, but not celecoxib use or vitamin B6 intake, may be associated with significantly increased OIPN severity.
Challenges in neoantigen-directed therapeutics
Authors: Lien Lybaert, Steve Lefever, Bruno Fant, Evelien Smits, Bruno De Geest, Karine Breckpot, Luc Dirix, Steven A. Feldman, Wim van Criekinge, Kris Thielemans, Sjoerd H. van der Burg, Patrick A. Ott, Cedric Bogaert
Journal: Cancer Cell (2022)
A Randomized, <scp>Placebo‐Controlled</scp> Phase <scp>III</scp> Extension Trial of the <scp>Long‐Term</scp> Safety and Tolerability of Anifrolumab in Active Systemic Lupus Erythematosus
Authors: Kenneth C. Kalunian, Richard Furie, Eric F. Morand, Ian N. Bruce, Susan Manzi, Yoshiya Tanaka, Kevin Winthrop, Ihor Hupka, Lijin (Jinny) Zhang, Shanti Werther, Gabriel Abreu, Micki Hultquist, Raj Tummala, Catharina Lindholm, Hussein Al‐Mossawi
Journal: Arthritis & Rheumatology (2022)

To explore long-term safety and tolerability of anifrolumab 300 mg compared with placebo in patients with systemic lupus erythematosus (SLE) who completed a Treatment of Uncontrolled Lupus via the Interferon Pathway (TULIP) trial and enrolled in the placebo-controlled 3-year long-term extension (LTE) study (ClinicalTrials.gov identifier: NCT02794285).
Not only mutations but also tumorigenesis can be substantially attributed to DNA damage from reactive oxygen species in RUNX1::RUNX1T1-fusion-positive acute myeloid leukemia
Authors: Jeffrey D. Mandell, J. Nick Fisk, Ethan Cyrenne, Mina L. Xu, Vincent L. Cannataro, Jeffrey P. Townsend
Journal: Leukemia (2022)
Cystic duct recanalization with a screw tip stent retriever aids plastic stent delivery in endoscopic transpapillary gallbladder drainage
Authors: Tesshin Ban, Yoshimasa Kubota, Takuya Takahama, Satoshi Tanida, Tomoaki Ando, Takashi Joh
Journal: Endoscopy (2022)

There are three nonsurgical gallbladder drainage methods available to treat patients with acute cholecystitis: percutaneous cholecystostomy, endoscopic transpapillary gallbladder drainage (ET-GBD), and endoscopic ultrasonography-guided drainage. ET-GBD is preferred in cases complicated by cholangitis/choledocholithiasis [1]. However, ET-GBD is technically challenging owing to the need to find the orifice of the cystic duct and to insert devices through a cystic duct that is long, narrow, tortuous, and inflamed by stone impaction [1]. This article presents a case in which the Soehendra stent retriever facilitated delivery of a plastic stent during ET-GBD.
Microglial Piezo1 senses Aβ fibril stiffness to restrict Alzheimer’s disease
Authors: Jin Hu, Qiang Chen, Hongrui Zhu, Lichao Hou, Wei Liu, Qihua Yang, Huidan Shen, Guolin Chai, Boxin Zhang, Shaoxuan Chen, Zhiyu Cai, Chongxin Wu, Fan Hong, Hongda Li, Sifang Chen, Naian Xiao, Zhan-xiang Wang, Xueqin Zhang, Bo Wang, Liang Zhang, Wei Mo
Journal: Neuron (2022)
Phase II Randomized Study of Salvage Radiation Therapy Plus Enzalutamide or Placebo for High-Risk Prostate-Specific Antigen Recurrent Prostate Cancer After Radical Prostatectomy: The SALV-ENZA Trial
Authors: Phuoc T. Tran, Kathryn Lowe, Hua-Ling Tsai, Daniel Y. Song, Arthur Y. Hung, Jason W.D. Hearn, Steven Miller, James A. Proudfoot, Matthew P. Deek, Ryan Phillips, Tamara Lotan, Channing J. Paller, Catherine H. Marshall, Mark Markowski, Shirl Dipasquale, Samuel Denmeade, Michael Carducci, Mario Eisenberger, Theodore L. DeWeese, Matthew Orton, Curtiland Deville, Elai Davicioni, Stanley L. Liauw, Elisabeth I. Heath, Stephen Greco, Neil B. Desai, Daniel E. Spratt, Felix Feng, Hao Wang, Tomasz M. Beer, Emmanuel S. Antonarakis
Journal: Journal of Clinical Oncology (2022)

We sought to investigate whether enzalutamide (ENZA), without concurrent androgen deprivation therapy, increases freedom from prostate-specific antigen (PSA) progression (FFPP) when combined with salvage radiation therapy (SRT) in men with recurrent prostate cancer after radical prostatectomy (RP).
Premiums and Out-of-Pocket Spending for Long-acting Insulins Under the Medicare Part D Senior Savings Model
Authors: Khrysta Baig, Stacie B. Dusetzina
Journal: JAMA (2022)

This study uses data from January/Q1 2022 Medicare Prescription Drug Plan Formulary files to compare premiums and total spending for users of long-acting insulin who selected prescription drug plans in 2022 and to estimate potential savings for beneficiaries who selected Senior Savings model-participating plans.
TREM2-independent microgliosis promotes tau-mediated neurodegeneration in the presence of ApoE4
Authors: Maud Gratuze, Johannes C.M. Schlachetzki, Ricardo D’Oliveira Albanus, Nimansha Jain, Brenna Novotny, Logan Brase, Lea Rodriguez, Clayton Mansel, Michal Kipnis, Sydney O’Brien, Martina P. Pasillas, Choonghee Lee, Melissa Manis, Marco Colonna, Oscar Harari, Christopher K. Glass, Jason D. Ulrich, David M. Holtzman
Journal: Neuron (2022)
Endoscopic ultrasound-guided fine-needle aspiration to diagnose a recurrent nasopharyngeal carcinoma in the parapharyngeal space
Authors: Zhen-Ming Zhang, Yu Bao, Hong Yang, Sheng Qin, Sha Zhang, Xun-Mei Duan
Journal: Endoscopy (2022)

A 46-year-old woman was referred to our hospital having suffered from persistent headache and hearing loss for 1 month. She had a previous history of nasopharyngeal carcinoma (NPC) after chemoradiotherapy. Magnetic resonance imaging revealed a soft tissue mass in the right parapharyngeal space (PPS) ([Fig.1 a, b]). Nasopharyngoscopy showed only scar-like changes in the nasopharynx ([Fig. 1 c, d]). Transnasal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed with the patient under total intravenous anesthesia ([Video 1]). A flexible echoendoscope (BF-UC260FW; Olympus, Japan) was introduced into the nasopharynx via the right nasal cavity. EUS revealed an irregularly shaped mass in the right PPS. The mass was predominantly heterogeneous hypoechoic mixed with spotted hyperechoic ([Fig. 2 a]). Guided by real-time ultrasonography, a 21-gauge needle (NA-201SX-4021; Olympus, Japan) was used to penetrate the PPS neoplasm ([Fig. 2 b]). To sample tissue, a syringe was used to introduce suction pressure. A total of three passes were performed. After the puncture procedure, a nasopharyngoscope was reinserted into the nasopharynx to exclude the presence of active bleeding from the puncture sites ([Fig. 2 c]). The acquired samples were sent for pathological examination ([Fig. 2 d]). Histopathology identified nonkeratinizing squamous cell carcinoma, and this was subsequently validated by immunohistochemistry ([Fig. 3]). The patient was diagnosed with recurrent NPC with a PPS lesion.
T-cell engaging poly(lactic-co-glycolic acid) nanoparticles as a modular platform to induce a potent cytotoxic immunogenic response against PD-L1 overexpressing cancer
Authors: Ramesh Duwa, Ram Hari Pokhrel, Asmita Banstola, Mahesh Pandit, Prakash Shrestha, Jee-Heon Jeong, Jae-Hoon Chang, Simmyung Yook
Journal: Biomaterials (2022)
Risk-Based Approaches to Breast Cancer Screening in China
Authors: Lydia E. Pace
Journal: JAMA Network Open (2022)

Yadi Zheng, BS; Xuesi Dong, PhD; Jiang Li, PhD; Chao Qin, PhD; Yongjie Xu, PhD; Fei Wang, PhD; Wei Cao, PhD; Changfa Xia, PhD; Yiwen Yu, MPH; Liang Zhao, BS; Zheng Wu, BS; Zilin Luo, BS; Wanqing Chen, PhD; Ni Li, PhD; Jie He, PhD
Perspectives of Emergency Clinicians About Medical Errors Resulting in Patient Harm or Malpractice Litigation
Authors: Daniel Ostrovsky, Victor Novack, Peter B. Smulowitz, Ryan C. Burke, Bruce E. Landon, Linda M. Isbell
Journal: JAMA Network Open (2022)

This cross-sectional study analyzes responses to a survey about medical error outcomes completed by emergency department attending physicians and advanced practice clinicians.
Efficacy and Safety of Low-Dose Interleukin 2 for Primary Sjögren Syndrome
Authors: Jing He, Jiali Chen, Miao Miao, Ruijun Zhang, Gong Cheng, Yifan Wang, Ruiling Feng, Bo Huang, Huijie Luan, Yuan Jia, Yuebo Jin, Xiaoying Zhang, Miao Shao, Yu Wang, Xia Zhang, Jing Li, Xiaozhen Zhao, Han Wang, Tian Liu, Xian Xiao, Xuewu Zhang, Yin Su, Rong Mu, Hua Ye, Ru Li, Xu Liu, Yanying Liu, Chun Li, Huixin Liu, Fanlei Hu, Jianping Guo, Wanli Liu, Wen-Bin Zhang, Alexander Jacob, Julian L. Ambrus, Changhai Ding, Di Yu, Xiaolin Sun, Zhanguo Li
Journal: JAMA Network Open (2022)

Primary Sjögren syndrome (pSS) is a systemic autoimmune disease associated with dysregulated immune cells, with no efficient therapy. There is a need to study potential therapeutic approaches.To investigate the efficacy, safety, and immune response of low-dose interleukin 2 (LD-IL-2) in the treatment of pSS.A double-blind, placebo-controlled randomized clinical trial was conducted with a 2-group superiority design from June 2015 to August 2017. Sixty patients, aged 18 to 70 years, were recruited from Peking University People's Hospital. Efficacy analyses were based on the intention-to-treat (ITT) principle. Data were analyzed from December 2018 to March 2020.Patients with pSS were treated with LD-IL-2 or placebo for 12 weeks and accompanied by 12 weeks of follow-up.The primary end point was defined as a 3-point or greater improvement on the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI) by week 24. The secondary end points included other clinical responses, safety, and changes of immune cell subsets at week 12 and 24.Sixty patients with pSS were recruited, with 30 in the LD-IL-2 group (mean [SD] age, 47.6 [12.8] years; 30 [100%] women) and 30 in the placebo group (mean [SD] age, 51.0 [11.9] years; 30 [100%] women), and 57 completed the trial. More patients in the LD-IL-2 group (20 [66.7%]) achieved ESSDAI score reduction of at least 3 points than in the placebo group (8 [26.7%]) at week 24 (P = .004). There were greater resolutions of dryness, pain, and fatigue in the LD-IL-2 group than placebo group at week 12 (dryness: difference, -18.33 points; 95% CI, -28.46 to -8.21 points; P = .001; pain: difference, -10.33 points; 95% CI, -19.38 to -1.29 points; P = .03; fatigue: difference, -11.67 points; 95% CI, -20.65 to -2.68 points; P = .01). No severe adverse events were observed in either group. In addition, the LD-IL-2 group showed a significant decrease in infection compared with the placebo group (1 [3.3%] vs 9 [30.0%]; P = .006). Immunological analysis revealed that LD-IL-2 promoted an expansion of regulatory T cells and regulatory CD24highCD27+ B cells.In this randomized clinical trial, LD-IL-2 was effective and well tolerated in patients with pSS, and it restored immune balance, with enhanced regulatory T cells and CD24highCD27+ B cells.ClinicalTrials.gov Identifier: NCT02464319.
Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care Practitioner
Authors: Esti Iturralde, Constance M. Weisner, Sara R. Adams, Felicia W. Chi, Thekla B. Ross, Sarah F. Cunningham, Murtuza Ghadiali, Asma H. Asyyed, Derek D. Satre, Cynthia I. Campbell, Stacy A. Sterling
Journal: JAMA Network Open (2022)

Importance Substance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services. Objective To examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of LINKAGE with improved care engagement in the short term. Design, Setting, and Participants In this post hoc analysis of a nonrandomized controlled trial, participants were assigned to the LINKAGE or usual care (UC) groups using a nonrandomized 3-month alternating off and on strategy over 30 months. Baseline through 5-year follow-up data were collected from April 2011 to October 2018. The trial was conducted at an urban outpatient addiction treatment clinic within a large health system among patients newly enrolled in addiction treatment. Data analysis was conducted from April 2021 to February 2022. Intervention The LINKAGE intervention included 6 group-based sessions emphasizing patient agency, skill, and motivation in navigating health care services as well as a facilitated telephone or email connection with a primary care practitioner. The UC group received medical education. Main Outcomes and Measures Substance use problem discussions with primary care practitioners (by patient self-report at 1-, 2-, and 5-year follow-up interview) and annual use of the electronic patient portal, primary care, and ED based on electronic health records. Results A total of 503 participants, with a mean (SD) age of 42 (12) years, 346 (69%) male participants and 37 (7%) African American, 34 (7%) Asian, and 101 (20%) Hispanic participants, were assigned to LINKAGE (252 participants) or UC (251 participants). Compared with UC participants, LINKAGE participants were significantly more likely to discuss substance use problems with a primary care practitioner at 1-year follow-up (risk ratio [RR], 1.30; 95% CI, 1.03-1.65; P = .03) and use the electronic patient portal at 1- and 2-year follow-up (eg, messaging clinicians at 2 years: RR, 1.24; 95% CI, 1.04-1.47; P = .02). The LINKAGE group had small, statistically significant 5-year annual increases in primary care use (RR, 1.03; 95% CI, 1.003-1.07; P = .03) and significant annual decreases in substance-related ED use (RR, 0.79; 95% CI, 0.64-0.97; P = .03), relative to UC. The LINKAGE group did not significantly differ from the UC group on other types of ED utilization. Conclusions and Relevance In this study, a patient activation intervention embedded in outpatient addiction treatment was associated with sustained improvements in health care engagement beyond previously reported 6-month outcomes and with long-term improvements in health care use patterns. Trial Registration ClinicalTrials.gov Identifier: NCT01621711
Gene flow and introgression are pervasive forces shaping the evolution of bacterial species
Authors: Awa Diop, Ellis L. Torrance, Caroline M. Stott, Louis-Marie Bobay
Journal: Genome biology (2022)

Abstract Background Although originally thought to evolve clonally, studies have revealed that most bacteria exchange DNA. However, it remains unclear to what extent gene flow shapes the evolution of bacterial genomes and maintains the cohesion of species. Results Here, we analyze the patterns of gene flow within and between &gt;2600 bacterial species. Our results show that fewer than 10% of bacterial species are truly clonal, indicating that purely asexual species are rare in nature. We further demonstrate that the taxonomic criterion of ~95% genome sequence identity routinely used to define bacterial species does not accurately represent a level of divergence that imposes an effective barrier to gene flow across bacterial species. Interruption of gene flow can occur at various sequence identities across lineages, generally from 90 to 98% genome identity. This likely explains why a ~95% genome sequence identity threshold has empirically been judged as a good approximation to define bacterial species. Our results support a universal mechanism where the availability of identical genomic DNA segments required to initiate homologous recombination is the primary determinant of gene flow and species boundaries in bacteria. We show that these barriers of gene flow remain porous since many distinct species maintain some level of gene flow, similar to introgression in sexual organisms. Conclusions Overall, bacterial evolution and speciation are likely shaped by similar forces driving the evolution of sexual organisms. Our findings support a model where the interruption of gene flow—although not necessarily the initial cause of speciation—leads to the establishment of permanent and irreversible species borders.